Disaster

Management
MOHAMMAD IRFAN
INTRODUCTION
• Disaster management in healthcare involves the systematic approach to
preparing for, responding to, and recovering from various types of disasters
that can impact healthcare systems and public health.
• These disasters can range from natural events like earthquakes, floods, and
pandemics to man-made incidents such as chemical spills, terrorist attacks,
and major accidents.
• Effective disaster management in healthcare requires comprehensive planning
and coordination.
• This includes risk assessment, emergency preparedness planning, resource
allocation, staff training, and community engagement.
• Healthcare facilities must collaborate with local, state, and central agencies,
other healthcare providers, and community organizations to ensure a
coordinated response.
History of Disaster Management
Ancient and Medieval Times
Early Civilizations: Ancient societies, such as those in Egypt and Mesopotamia,
implemented early public health measures to combat infectious diseases and
manage natural disasters like floods.
Medieval Period: Responses to pandemics, such as the Black Death, involved
quarantine measures and early public health practices aimed at containing the
spread of disease.
19th Century
Formation of the Red Cross: The establishment of the International Red Cross in
1863 marked the beginning of organized humanitarian aid and disaster relief,
focusing on providing medical assistance during emergencies.
Urban Disasters: Major fires in urban areas, such as the Great Fire of London
(1666) and the Chicago Fire (1871), led to improved urban planning, building
codes, and the establishment of fire brigades
Early 20th Century
World Wars: The medical and logistical challenges of World Wars I and II
prompted significant advancements in trauma care, the establishment of
military medical corps, and innovations in emergency medical services.
Public Health Advances: The early 20th century saw improvements in public
health infrastructure, vaccines, and antibiotics, which enhanced the ability to
manage infectious disease outbreaks.
Recent Decades
September 11 Attacks (2001): The 9/11 terrorist attacks led to major changes in
disaster preparedness, focusing on counter-terrorism and emergency response
within healthcare systems.
Pandemics: Outbreaks like SARS (2003) and H1N1 influenza (2009) underscored
the need for global surveillance and rapid response capabilities in healthcare.
Hurricane Katrina (2005): The response to Hurricane Katrina revealed significant
gaps in emergency preparedness, prompting reforms in disaster management
practices in the U.S.
Indian Ocean Tsunami (2004): This disaster led to the establishment of early
warning systems and increased international cooperation in disaster response.
21st Century Developments
COVID-19 Pandemic: The COVID-19 pandemic has emphasized the critical role
of healthcare systems in managing large-scale health emergencies, driving
innovations in telemedicine, vaccine development, and emergency response
coordination.
Technological Advancements: The use of GIS, big data analytics, and
telemedicine has transformed disaster management, enabling better prediction,
response, and recovery efforts.
Mass Casualty Incident (MCI)
• An incident which generates more patients at one time than locally available
resources can manage using routine procedures.
• It requires exceptional emergency arrangements and additional or
extraordinary assistance.
• The Objective of MCI is to move all patients to a medical facility as soon as
possible.
• One has to do what is practically possible for the greatest number of victims.
TYPES OF DISASTER
Hospitals &Disaster
• Hospitals serve as the major resource for the intake, evaluation &treatment of
patients affected by disaster.
• It is vital that hospital preparedness personnel identify vulnerable people,
structures and services in their hospital community so that these can be made
more resilient to the effects of disaster.
Issues to be addressed by
Hospital
1 Surge capacity for additional space for treatment and evaluation.
2. Medication and supply stockpiles
3. Structural integrity
4. Trained staff
5. Response protocol and proper disaster response procedures.
6. Functional hospital based disaster plan
Steps in MCI Management
1. Triage
2. Primary Survey
3. Secondary Survey
4. Treatment
5. Documentation
Triage
• A method of quickly identifying victims who have immediately life-threatening
injuries AND who have the best chance of surviving.
• Aim of triage : To achieve the greatest good for the greatest number of
casualty
Types of Triage
◦ M.A.S.S. Triage : based on patients ability to move
◦ S.T.A.R.T. Triage : determines severity of injuries
◦ Advanced Triage : More fully assess injury priority
Concept of "Golden Hour"
• Golden Hour is a concept of trauma care developed by Dr Adams Cowley
• Refers to the amount of time from injury to definitive care that should be
allotted to maximize survival from traumatic injury.
• Most studies have shown, if care given within first hour of injury morbidity
and mortality can be reduced.
Primary Survey (ABCDE
Approach):
•A = Airway: Assess and maintain a patent airway. Protect cervical spine if trauma is
suspected. Methods include head tilt/chin lift, jaw thrust, and use of airway adjuncts.
• B = Breathing: Evaluate breathing adequacy, assess for signs of respiratory distress or
obstruction, and manage with oxygen.
• C = Circulation: Check for signs of shock and assess perfusion parameters
• D = Disability: Perform a rapid neurological assessment to detect any deficits.
• E = Exposure/Environmental Control: Conduct a systematic head-to-toe examination,
ensuring proper immobilization if spinal injury is suspected, and prevent hypothermia .
Secondary Survey:
• Secondary survey is undertaken when the patient's ABCs are stable
• To identify all minor injuries missed in primary survey
• to identify any additional injuries through detailed patient history, thorough
physical examination, and appropriate diagnostic tests.
The Threat
• Mass casualty respiratory failure poses a significant threat during disasters
• especially those involving infectious diseases, chemical exposures, or
environmental hazards.
• These scenarios can overwhelm healthcare systems, leading to a scarcity of
resources such as ventilators, personal protective equipment (PPE), and
trained personnel.
• For physiotherapists understanding the nature of these threats is crucial for
effective intervention.
Respiratory failure in mass
casualty events can result from:
• Pandemics: Widespread respiratory infections can lead to severe acute
respiratory distress syndrome (ARDS), necessitating ventilatory support.
• Chemical Exposures: Inhalation of toxic substances can cause immediate and
severe respiratory compromise.
• Natural Disasters: Dust, smoke, and debris inhalation can lead to acute and
chronic respiratory conditions.
• Terrorist Attacks: Use of chemical, biological, radiological, and nuclear (CBRN)
agents can result in widespread respiratory failure.
Planning for Mass Casualty
Respiratory Failure
• Risk Assessment: Identifying potential hazards and assessing the likelihood
and impact of respiratory failure in various disaster scenarios.
• Resource Allocation: Ensuring adequate supplies of ventilators, oxygen, and
medications. Stockpiling PPE and establishing protocols for their use.
• Training: Providing specialized training for healthcare workers, including
physiotherapists, in the management of respiratory failure and the use of
advanced ventilatory support techniques.
• Surge Capacity: Developing plans to expand healthcare capacity rapidly in
response to a sudden influx of patients. This includes setting up temporary
care facilities and repurposing existing spaces.
• Coordination and Communication: Establishing clear communication
channels between different agencies and healthcare providers to ensure a
coordinated response.
• Public Awareness: Educating the public about respiratory health and
preventive measures to reduce the incidence of respiratory failure during
disasters.
Personal Protective
Equipment (PPE)
PPE is crucial for protecting healthcare workers, including physiotherapists,
from infection and exposure to hazardous materials during disaster response.
Key components of PPE include:
• Masks and Respirators: N95 respirators or higher-level protection to filter
airborne particles.
• Gloves: To prevent contamination from surfaces and patient contact.
• Gowns and Aprons: To protect clothing and skin from exposure to infectious
agents and chemicals.
• Eye Protection: Goggles or face shields to prevent exposure to splashes and
aerosols.
• Boot Covers: To prevent contamination of footwear and reduce the spread of
pathogens.
Proper training in the use and disposal of PPE is essential to ensure maximum
protection and prevent self-contamination.
Ventilator Management in Mass
Casualty Respiratory Failure
Ventilator management during mass casualty events is a critical
component of disaster response. Key considerations include:
• Triage: Prioritizing patients based on the severity of their condition and the
likelihood of benefit from ventilatory support.
• Ventilator Allocation: Ensuring equitable distribution of ventilators and
optimizing their use to maximize survival rates.
• Prone Positioning: Implementing prone positioning to improve oxygenation in
patients with ARDS.
• Weaning Protocols: Developing protocols for the timely weaning of patients
from ventilators to free up resources for others in need.
• Monitoring and Adjustments: Continuous monitoring of ventilated patients
and adjusting settings based on their evolving clinical condition.
THANK YOU